What is Forensic Psychiatry?Forensic psychiatry has two main components:· Clinical assessment and treatment of individuals in a variety of settings and under arange of circumstances. Patients are frequently involved in the criminal justice system,either awaiting trial or having been convicted of an offence. Forensic services also offeradvice to general psychiatric services concerning patients suffering from severe mentaldisorder in association with severe behavioural disturbance or if there are concerns aboutthe level of risk posed..· Application of the law to clinical practice, presenting relevant psychiatric informationand conclusions to various legal and statutory agencies. This is frequently in the form ofexpert opinion given in court reports, in which psychiatric issues which may prove ofimportance in the case can be considered in detail. This may be in civil or criminal cases.There are a number of important topics associated with the theory behind forensicpsychiatry which will be covered. These are as follows:1. Criminology2. Crime in the UK3. Antisocial behaviour ­ epidemiology and aetiology4. Psychiatric aspects of offending behaviour5. Offending amongst those with mental disorder6. Sexual offences7. Risk assessment8. The UK criminal justice system9. Mental disorder in prisonDetailed knowledge of mental health legislation is not covered, and it is slightly different inScotland and Ireland as compared to England and Wales. A new Mental Health Act forEngland and Wales was passed in 2007, but it is not likely to come into force until late 2008.CriminologyCriminology is a general term for the study of crime. It has traditionally been sociologistswho have studied crime, but in recent times lawyers, psychologists and other professionalshave become involved. There are a wide range of theories underlying why individualscommit crime, but there remains little consensus. Crime is by nature a difficult subject tostudy, as those directly involved are the least likely to report their activities. Similarly,understanding the prevalence of crime is difficult. There are two main approaches used toestimate the extent of crime in the UK:· Police data concerning crimes reported, investigated and concluded· Population questionnaires asking about individual experiences of crimeThe first approach might be thought to be more robust, as the police exist specifically to dealwith crime and offending behaviour and they have a range of mechanisms for identifyingand investigating.1 However, generally this relies on crime being reported to them in thefirst place, and this frequently does not occur, especially for petty offences. Also, not allcrime reported to the police is officially recorded. This is only done for so called `notifiableoffences', which have to be reported to the Home Office. There are a variety of complicatedrules for police concerning how a crime is recorded. For example, if three items are stolenshould it be recorded as one crime or three? If a house is burgled and a wide variety of itemstaken, how many crimes should be recorded? As a general rule, crimes are countedaccording to the number of victims on a `one crime per victim' basis.2The second approach is that taken by the British Crime Survey (BCS) which is published

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It collects information about crime independently of that recorded by the police.The BCS estimates that 11.3 million crimes were committed in the year 2006 2007, of which5.4m were reported to police. An even smaller proportion will therefore have beeninvestigated and convictions secured. The overall amount of crime appears to be remainingstable although the amount reported to police is diminishing slightly. However, the BCSlooks at a more limited range of offences than those recorded by the police (predominatelyviolence and theft).…read more

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· Twin studies show genetic overlap of disinhibitory syndromes: conduct disorder, alcoholand drug dependence and child and adult antisocial behaviour. It is postulated thatthere is an underlying genetic vulnerability factor to these disorders (termed as`externalising' disorders) related to behavioural under control. 5Neurobiological factorsThere has been a considerable body of research directed at examining the role of serotonin indriving aggressive behaviour.…read more

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Psychiatric Aspects of Offending Behaviour.The relationship between psychiatric disorder and criminal behaviour is far fromstraightforward. Few psychiatric patients are offenders and few offenders have a psychiatricdisorder (Gunn, 1977). The public image of mental illness is generally poor, and mediaportrayal of certain illnesses (particularly schizophrenia) has led to high public anxiety andpoor understanding. However, the previously accepted view that those with mental illnesswere no more dangerous than anyone else is not entirely true either.Acquisitive Crime.…read more

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· Birth cohort studieso There have been a number of studies conducted using this design, and mosthave broadly supported the hypothesis that major mental illness is associatedwith an increased likelihood of violence (or arrest for violence). This isparticularly so amongst women, who are less likely to be convicted of violentoffences than men.· Prevalence studies amongst violent populationso There has been a considerable amount of work aimed at investigatingpopulations of those who have committed violent acts.…read more

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England and Wales.· 34% had a mental disorder: most had not attended mental health services· 5% had a diagnosis of schizophrenia· 10% had mental illness at the time of the offence· 9% received a diminished responsibility verdict· Most perpetrators with a history of mental disorder were not acutely ill when theykilled, and most had never received mental healthcare, suggesting that services couldnot have prevented their offences (Shaw et al 2006).…read more

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Those who have committed numerous crimes are almost by definition antisocial,but simply being a criminal alone is not enough to warrant the diagnosis . 19Recent political debate has introduced the concept of `dangerous and severe personalitydisorder' (DSPD). This is not a diagnosis as such, but is used by politicians to refer toparticularly high risk individuals.…read more

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There is little evidence to suggest that criminalbehaviour is higher in cannabis users (with the obvious exception of convictions forpossession). 80% of opiate users have at least one conviction.25Organic disordersDisinhibition and impaired judgement, characteristic of organic brain disease, may lead tominor crimes of dishonesty or sexual offences. The few elderly offenders who are convictedof crimes have high rates of alcohol misuse. In younger men, offending may be associatedwith any cause of organic brain disease.…read more

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Magistrates Court. Most sexualoffenders do not have a mental illness and are dealt with by the criminal justice system.RapeRape is a violent sexual offence, in which an individual has unlawful sexual intercourse witha man or woman who is not consenting, and when the perpetrator either knows that they arenot consenting or is reckless to whether or not they consent. Most rapists are known to theirvictims, and most rapes take place in the home.…read more

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This refers to arousal to symbols of sexuality, which may develop into the predominant orexclusive form of sexual outlet. It is a learned response and is therefore amenable tobehavioural treatment such as aversive conditioning, reconditioning and counterconditioning.Exhibitionism and indecent exposureIndecent exposure is the legal term for the offence of indecently exposing the genitals toother people. In England and Wales it is one of the most common sexual offences. It is mostcommon in men aged between 25 and 35.…read more